title: Emergency ventricular pacing using a J-electrode catheter without fluoroscopy.
abstract: The initiation of emergency ventricular pacing may be delayed by a lack of facilities for immediate fluoroscopy or staff members who are skilled in positioning a transvenous electrode catheter. Techniques have been developed to overcome these problems but have been unreliable, expensive and/or uncomfortable for patients. In each of 20 consecutive haemodynamically unstable patients (13 patients with asystole or high-grade atrioventricular block and seven patients with ventricular tachycardia), an attempt was made to pace the ventricle with a Cordis 5-FG (1.67-mm) "atrial J"-electrode catheter, which was inserted transvenously without fluoroscopic guidance. Pacing was initiated successfully in 19 cases within 40 seconds to 30 minutes (median, two minutes) of skin puncture, and in 16 cases within three minutes. Fifteen procedures were performed by operators with experience of less than 10 previous pacing catheter insertions. This study demonstrates that emergency transvenous ventricular pacing can be initiated rapidly and reliably by means of a catheter with a "J" configuration, which is inserted without the use of fluoroscopy. The method can be employed successfully by operators with little experience in pacing techniques. Standard inexpensive equipment is used; the technique is safe and well-tolerated by patients.
authors.affiliation: Department of Cardiology, Royal Perth Hospital, WA.
authors.forename: M J
authors.initials: MJ
authors.lastname: Davis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D004567:Electrodes, Implanted; D004630:Emergencies; D005069:Evaluation Studies as Topic; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D013350:Subclavian Vein; D013997:Time Factors